Tourette syndrome and nutritional implications

Gilles de la Tourette syndrome (GTS) is a neurodevelopmental disorder defined by multiple motor tics and at least one sound tic. Various behavioural symptoms are associated with GTS, especially obsession and compulsion behaviours (OCBs), attention-deficit/hyperactivity disorder (ADHD) and poor impulse control. These comorbid conditions have a high impact on patients quality of life, including eating attitudes and body image perception. Nutritional implications, together with sleepiness and sexual asthenia, are the principal side effects of the pharmacological therapy. Actually, drugs may compromise the nutritional status of patients producing appetite increase, dry mouth, constipation, glucose and lipid metabolism abnormalities, metabolic syndrome, mild transient dysphagia and nausea. About 40% of GTS patients experience hyperphagia because of drug side effects, OCBs, ADHD, or poor impulse control. Consequently, in these cases an overweight status can occur, complicating the management of the symptoms. Therefore, an increase body weight should be considered one of the most relevant factors increasing GTS drug-related bad compliance, which may consequently cause in some patients the discontinuation/interruption of the pharmacological therapy

Why so many deep brain stimulation targets in Tourette's syndrome? Toward a broadening of the definition of the syndrome

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Socio-demographic and clinical characterization of patients with obsessive-compulsive tic-related disorder (OCTD) : An Italian multicenter study

© Copyright by Pacini Editore SrlIn the DSM-5 a new "tic-related" specifier for obsessive compulsive disorder (OCD) has been introduced, highlighting the importance of an accurate characterization of patients suffering from obsessive-compulsive tic-related disorder ("OCTD"). In order to characterize OCTD from a socio-demographic and clinical perspective, the present multicenter study was carried out. The sample consists of 266 patients, divided in two groups with lifetime diagnoses of OCD and OCTD, respectively. OCTD vs OCD patients showed a significant male prevalence (68.5% vs 48.5%; p < .001), a higher rate of psychiatric comorbidities (69.4 vs 50%; p < .001) - mainly with neurodevelopmental disorders (24 vs 0%; p < .001), a lower education level and professional status (middle school diploma: 25 vs 7.6%; full-Time job 44.4 vs 58%; p < .001). Moreover, OCTD vs OCD patients showed significantly earlier age of OCD and psychiatric comorbidity onsets (16.1 ± 10.8 vs 22.1 ± 9.5 years; p < .001, and 18.3 ± 12.8 vs 25.6 ± 9.4: p < .001, respectively). Patients with OCTD patients were treated mainly with antipsychotic and with a low rate of benzodiazepine (74.2 vs 38.2% and 20.2 vs 31.3%, respectively; p < .001). Finally, OCTD vs OCD patients showed higher rates of partial treatment response (58.1 vs 38%; p < .001), lower rates of current remission (35.5 vs 54.8%; p < .001) and higher rates of suicidal ideation (63.2 vs 41.7%; p < .001) and attempts (28.9 vs 8.3%; p < .001). Patients with OCTD report several unfavorable socio-demographic and clinical characteristics compared to OCD patients without a history of tic. Additional studies on larger sample are needed to further characterize OCTD patients from clinical and therapeutic perspectives.Peer reviewedFinal Published versio

Ablative brain surgery : an overview

Background: Ablative therapies have been used for the treatment of neurological disorders for many years. They have been used both for creating therapeutic lesions within dysfunctional brain circuits and to destroy intracranial tumors and space-occupying masses. Despite the introduction of new effective drugs and neuromodulative techniques, which became more popular and subsequently caused brain ablation techniques to fall out favor, recent technological advances have led to the resurgence of lesioning with an improved safety profile. Currently, the four main ablative techniques that are used for ablative brain surgery are radiofrequency thermoablation, stereotactic radiosurgery, laser interstitial thermal therapy and magnetic resonance-guided focused ultrasound thermal ablation. Object: To review the physical principles underlying brain ablative therapies and to describe their use for neurological disorders. Methods: The literature regarding the neurosurgical applications of brain ablative therapies has been reviewed. Results: Ablative treatments have been used for several neurological disorders, including movement disorders, psychiatric disorders, chronic pain, drug-resistant epilepsy and brain tumors. Conclusions: There are several ongoing efforts to use novel ablative therapies directed towards the brain. The recent development of techniques that allow for precise targeting, accurate delivery of thermal doses and real-time visualization of induced tissue damage during the procedure have resulted in novel techniques for cerebral ablation such as magnetic resonance-guided focused ultrasound or laser interstitial thermal therapy. However, older techniques such as radiofrequency thermal ablation or stereotactic radiosurgery still have a pivotal role in the management of a variety of neurological disorders

Marine alien species in Italy: A contribution to the implementation of descriptor D2 of the Marine Strategy Framework Directive

A re-examination of marine alien species or Non Indigenous Species (NIS) reported in Italian Seas, until December 2018, is provided, focusing on establishment success, year of first record, origin, potential invasiveness, and likely pathways, in particular. Furthermore, their distribution is assessed according to the marine subregions outlined by the European Union (EU) Marine Strategy Framework Directive: Adriatic Sea (ADRIA), Ionian Sea and Central Mediterranean Sea (CMED), and Western Mediterranean Sea (WMED). In Italy, 265 NIS have been detected with the highest number of species being recorded in the CMED (154 species) and the WMED (151 species) subregions, followed by the ADRIA (143) subregion. Most of these species were recorded in more than one subregion. One hundred and eighty (180 or 68%) NIS have established stable populations in Italian Seas among which 26 have exhibited invasive traits. As regards the taxa involved, Macrophyta rank first with 65 taxa. Fifty-five of them are established in at least one subregion, mostly in the ADRIA and the CMED. Crustacea rank second with 48 taxa, followed by Polychaeta with 43 taxa, Mollusca with 29 taxa, and Fishes with 28 taxa, which were mainly reported from the CMED. In the period 2012-2017, 44 new alien species were recorded, resulting in approximately one new entry every two months. Approximately half of the NIS (~52%) recorded in Italy have most likely arrived through the transport-stowaway pathway related to shipping traffic (~28% as biofoulers, ~22% in ballast waters, and ~2% as hitchhikers). The second most common pathway is the unaided movement with currents (~19%), followed by the transport-contaminant on farmed shellfishes pathway (~18%). "Unaided" is the most common pathway for alien Fishes, especially in the CMED; escapes from confinement account for ~3% and release in nature for ~2%. The present NIS distribution hotspots for new introductions were defined at the first recipient area/location in Italy. In the ADRIA, the hotspot, Venice, accounts for the highest number of alien taxa introduced in Italy, with 50 newly recorded taxa. In the CMED subregion, the hotspots of introduction are the Taranto and Catania Gulfs, hosting 21 first records each. The Strait of Sicily represents a crossroad between alien taxa from the Atlantic Ocean and the Indo-Pacific area. In the WMED, bioinvasion hotspots include the Gulfs of Naples, Genoa and Livorno. This review can serve as an updated baseline for future coordination and harmonization of monitoring initiatives under international, EU and regional policies, for the compilation of new data from established monitoring programs, and for rapid assessment surveys

Basal Ganglia Pathways Associated With Therapeutic Pallidal Deep Brain Stimulation for Tourette Syndrome

BACKGROUND: Deep brain stimulation (DBS) targeting the globus pallidus internus (GPi) can improve tics and comorbid obsessive-compulsive behavior (OCB) in patients with treatment-refractory Tourette syndrome (TS). However, some patients’ symptoms remain unresponsive, the stimulation applied across patients is variable, and the mechanisms underlying improvement are unclear. Identifying the fiber pathways surrounding the GPi that are associated with improvement could provide mechanistic insight and refine targeting strategies to improve outcomes. METHODS: Retrospective data were collected for 35 patients who underwent bilateral GPi DBS for TS. Computational models of fiber tract activation were constructed using patient-specific lead locations and stimulation settings to evaluate the effects of DBS on basal ganglia pathways and the internal capsule. We first evaluated the relationship between activation of individual pathways and symptom improvement. Next, linear mixed-effects models with combinations of pathways and clinical variables were compared in order to identify the best-fit predictive models of tic and OCB improvement. RESULTS: The best-fit model of tic improvement included baseline severity and the associative pallido-subthalamic pathway. The best-fit model of OCB improvement included baseline severity and the sensorimotor pallidosubthalamic pathway, with substantial evidence also supporting the involvement of the prefrontal, motor, and premotor internal capsule pathways. The best-fit models of tic and OCB improvement predicted outcomes across the cohort and in cross-validation. CONCLUSIONS: Differences in fiber pathway activation likely contribute to variable outcomes of DBS for TS. Computational models of pathway activation could be used to develop novel approaches for preoperative targeting and selecting stimulation parameters to improve patient outcomes

New Mediterranean Biodiversity Records (July 2016)

This contribution forms part of a series of collective articles published regularly in Mediterranean Marine Science that report on new biodiversity records from the Mediterranean basin. The current article presents 51 geographically distinct records for 21 taxa belonging to 6 Phyla, extending from the western Mediterranean to the Levantine. The new records, per country, are as follows: Spain: the cryptogenic calcareous sponge Paraleucilla magna is reported from a new location in the Alicante region. Algeria: the rare Atlanto-Mediterranean bivalve Cardium indicum is reported from Annaba. Tunisia: new distribution records for the Indo-Pacific lionfish Pterois miles from Zembra Island and Cape Bon. Italy: the ark clam Anadara transversa is reported from mussel cultures in the Gulf of Naples, while the amphipod Caprella scaura and the isopods Paracerceis sculpta and Paranthura japonica are reported as associated to the –also allochthonous–bryozoan Amathia verticillata in the Adriatic Sea; in the latter region, the cosmopolitan Atlantic tripletail Lobotes surinamensisis also reported, a rare finding for the Mediterranean. Slovenia: a new record of the non-indigenous nudibranch Polycera hedgpethi in the Adriatic. Greece: several new reports of the introduced scleractinian Oculina patagonica, the fangtooth moray Enchelycore anatina, the blunthead puffer Sphoeroides pachygaster (all Atlantic), and the lionfish Pterois miles (Indo-Pacific) suggest their ongoing establishment in the Aegean Sea; the deepest bathymetric record of the invasive alga Caulerpa cylindracea in the Mediterranean Sea is also registered in the Kyklades, at depths exceeding 70 m. Turkey: new distribution records for two non indigenous crustaceans, the blue crab Callinectes sapidus (Atlantic origin) and the moon crab Matuta victor (Indo-Pacific origin) from the Bay of Izmir and Antalya, respectively; in the latter region, the Red Sea goatfish Parupeneus forsskali, is also reported. Lebanon: an array of records of 5 alien and one native Mediterranean species is reported by citizen-scientists; the Pacific jellyfish Phyllorhiza punctata and the Indo-Pacific teleosteans Tylerius spinosissimus, Ostracion cubicus, and Lutjanus argentimaculatus are reported from the Lebanese coast, the latter notably being the second record for the species in the Mediterranean Sea since 1977; the native sand snake-eel Ophisurus serpens, rare in the eastern Mediterranean, is reported for the first time from Lebanon, this being its easternmost distribution range; finally, a substantial number of sightings of the lionfish Pterois miles further confirm the current establishment of this lessepsian species in the Levantine

The International Deep Brain Stimulation Registry and Database for Gilles de la Tourette Syndrome: How Does It Work?

Tourette Syndrome (TS) is a neuropsychiatric disease characterized by a combination of motor and vocal tics. Deep brain stimulation (DBS), already widely utilized for Parkinson's disease and other movement disorders, is an emerging therapy for select and severe cases of TS that are resistant to medication and behavioral therapy. Over the last two decades, DBS has been used experimentally to manage severe TS cases. The results of case reports and small case series have been variable but in general positive. The reported interventions have, however, been variable, and there remain non-standardized selection criteria, various brain targets, differences in hardware, as well as variability in the programming parameters utilized. DBS centers perform only a handful of TS DBS cases each year, making large-scale outcomes difficult to study and to interpret. These limitations, coupled with the variable effect of surgery, and the overall small numbers of TS patients with DBS worldwide, have delayed regulatory agency approval (e.g., FDA and equivalent agencies around the world). The Tourette Association of America, in response to the worldwide need for a more organized and collaborative effort, launched an international TS DBS registry and database. The main goal of the project has been to share data, uncover best practices, improve outcomes, and to provide critical information to regulatory agencies. The international registry and database has improved the communication and collaboration among TS DBS centers worldwide. In this paper we will review some of the key operation details for the international TS DBS database and registry